There are countless options. We going to quote the main options with the impact to reduce and/or prevent a blood transfusion.

1 – Tolerance to anemia.. The patient tolerates anemia, the doctor cooperates with the patient in tolerating anemia. This tolerance is individual. Learn more with the second question of this section.
2 – Medicines for treating anemia.. Ferrous sulphate, folic acid, vitamin B12, erythropoietin.

3 – Medicines of systemic usage (intravenous) to stop bleeding and prevent blood transfusion:: tranexamic acid, epsilon aminocaproic acid,vasopressin, desmopressin acetate, vitamin K, activated recombinant factor VII, coagulation factor VIII concentrated, prothrombin complex concentrated, human fibrinogen concentrated, human recombinant factor XIII. Dosages of
these drugs are found at the article “Therapeutic options to minimize allogeneic blood transfusions and their adverse events in cardiac surgery: Systematic review”.

4 – Topical usage medicines to stop the bleeding and avoid blood transfusion: oxidized cellulose hemostat for the wound’s compression; fibrin glue/sealant; fibrin or platelets gel; hemostatic collagen; gelatin foam/sponges; calcium alginate.

5 – Equipment that avoids blood transfusion (cell saver):: This equipment recovers the patient’s blood that otherwise would be lost during the surgery. The interesting fact to consider is that this recovered blood has the patient’s DNA. This blood can be reused and does not represent a hemotoxin (“foreign body”). This is a true blood’s “recycling”. This is the best blood that a patient could receive in a transfusion: HIS OWN BLOOD.

The intraoperative autotransfusion is an excellent alternative to allogeneic blood, primarily because the benefits such as: availability of fresh blood, decreased postoperative complications, reduction of number of days of hospitalization and associated infections, reduction of death and decreases the homologous blood demand (donated blood).

6 – Acute normovolemic hemodilution.. It consists of the withdrawing of one, two, three or more bags of the patient’s blood at the beginning of the surgery,

being replaced by crystalloid and/or colloid solutions such as plasma volume expanders, in order to maintain normovolemia. This blood will be at the surgeon’s disposal to be used in the appropriate time, usually at the end of surgery. In case of any bleeding in surgery, we will have less blood loss, as it will be diluted. This stored blood has the patient’s DNA without the risk of immunological reactions.

7 – Surgical techniques.. It is also a treatment option for reducing the use of blood transfusions. This strategy involves meticulous hemostasis, a hypotensive anesthesia and mild hypothermia to prevent loss of blood, and consequently, less consumption of blood. 

8 – Avoid excessive blood samples.Withdrawing of blood three, four, five or more times in one day, from the same patient, only to follow a routine or some
arbitrary protocol of certain intensive care unit (ICU), for sure will cause an iatrogenic anemia and consequently result in an also iatrogenic blood transfusion.Therefore, excessive blood withdrawal causes anemia, and as most doctors will not tolerate anemia, the result is a transfusion.

Therefore, always ask your doctor if this withdrawal will change the conduct, that is, if it will guide further treatment. Otherwise, the withdrawn blood will only contribute to worsen the clinical condition.

9 – Use of pediatric tubes for collecting blood. The more blood is withdrawn from a patient, especially when he is hospitalized, the worse will be his health condition. What is proposed is to collect a minimum of blood needed to carry out essential laboratory tests. The objective of this strategy is to avoid unnecessary blood loss and hence avoid blood transfusions. Ask your doctor about this.

10 – Early oxygen therapy/Supplemental oxygen. Tolerance to anemia can be increased by ventilating the patient with a high fraction of inspired oxygen (FiO2). Ventilate with 100% oxygen results in rapid increase in arterial oxygen content, ensuring tissue oxygenation even with very low hemoglobin (severe anemia) and it proves to be an important strategy for reducing allogeneic transfusion.

11– Other therapeutic options are found in the article” Therapeutic options to minimize allogeneic blood transfusions and their adverse events in cardiac surgery: Systematic review “,, publicado na Rev Bras Cir Cardiovasc. published by Rev Bras Cir Cardiovasc. 2014;29(4):606-21, available in the following link:–a-systematic-review

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